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Fingers: Cysts

I have a retinacular cyst at the MCP joint of my left ring finger. My doc aspirated it but it came back within the same week. My doc wants to do an MRI, which may or may not be followed by surgery depending on the size of the tear in my tendon sheath. He told me he doesn't think the tear is big, in which case I will be told to rest for four (or more) months! I haven't climbed since March and I'm going crazy. The cyst is back to its original angry size, and has not diminished with rest. Should I rest it and take up swimming, or is surgery the only way out?

EILY MORAN
ALBUQUERQUE, NEW MEXICO

Well, you are in a spot of bother. Although technically climbing would do very little to the actual cyst in biomechanical terms, pressure on it will usually cause varying amounts of discomfort depending on where it sits. Jugs are, ironically, often worse than smaller holds.

Sucking the guts out of it (aspirating) will typically be a failure. Cortisone is likely to be a close second, though there is a slim chance it would work. Failure rates are thought to be somewhere around 50 percent, though I would say that figure is optimistic.

Surgery is a much better shot, with failure rates around 20 percent. Recovery would also be considerable, though not four months. I would expect more like two months, with your entrance back into the cathedral of climbing to progress thereafter. The good thing is that there is no hurry to exercise this option.

Climbing is only a problem when you put pressure on the cyst. If it were in a less prominent position, it would not be an issue at all. Usually they go away, but the timeline is largely unknown; they can sit there for years, or maybe just months.

My advice would be to get so strong you can hang onto holds that don't put pressure on it. The stronger you are, the smaller a jug actually becomes. Bouldering, because it involves smaller holds, is often less aggravating. When you have a jug, hold it so that there is no pressure on the cyst. This may not be the best formula for recovery, but there is no evidence that rest is any better. They come, they go and God only knows why.

On that note, the Bible and all its variations have been used as a manifesto of carnage for centuries. Nothing much has changed recently, though in addition to wreaking havoc on the wide variety of disbelievers, you can also use a heavy book to bludgeon, not metaphorically in this instance, your cyst to smithereens. It's a miracle! The good lord, whatever his name, works in mysterious ways and irony is one of his strong points.

Hitting and breaking your cyst will be cheaper and more effective than anything. This is usually reserved for cysts on the back of your wrist that are more accessible. I am not convinced yours will be an easy target. A few patients have asked me to do it, but my insurance company says blunt trauma is not covered in my policy. Go figure.

Other than surgery or waiting and watching, acupuncture might work. I have seen great results for conditions like trigger finger, which is a similar type of pathology. You would need to speak to an acupuncturist about this.

Drop me a message on the forum at rockandice.com and let me know what you decide and how you get on.